by Tracy Kidder
Eventually, they got free, and Paul drove to the Lafontants’ house. She got out, but he stayed behind the wheel. “I have to go back, Min.”
“P.J., please don’t.”
But he went, right back into the thick of the trouble, demonstrators climbing over the car while soldiers clubbed them. He took several more bloodied civilians in, and came back unbloodied himself. “It was very important to Paul to witness things,” Ophelia would say, looking back. She went on, “That smell of burning tires never quite leaves you. The smell is forever associated for me with political violence.”
There wasn’t much of that out in Cange, but even there the change in atmosphere was obvious. In previous years, before Baby Doc’s forced departure, the peasants had rarely dared to talk politics. Now, as a saying went, baboukèt la tonbe—the muzzle had fallen off. Farmer would later write, “Not only were the villagers talking about subjects previously forbidden, they were talking about old subjects in new ways.” They were no longer merely asking if infant diarrhea was caused by germs but asking whether the germs were caused by dirty water. And didn’t dirty water come from the neglect of feckless, greedy governments?
For many years to come, the smell of burning tires, the smell of revolt, of roadblocks and massacres, would be an abiding odor in Haiti, and in Ophelia’s life and Paul’s.
In 1988 Ophelia came to Boston to live with Paul. By now he had entered the phase of medical school known as clinical rotations, stretches of training at Boston hospitals, usually lasting a month apiece. Paul rarely missed a day of those. But even when he was in Boston, Haiti was never far from his thoughts. He had said to Ophelia when she’d begun working with him in Cange, “We need to bring resources down here. Will you help me?” Back in England after the summer of 1985, she had done some modest fund-raising of her own and, on Paul’s instructions, bought ten scales for weighing babies, to use for identifying infants at risk in the continuing health census. She brought the scales and the remaining cash to Cange the following summer.
By then they had begun to talk about creating an organization that would support the growing health system around Cange. Tom White agreed to pitch in, and in 1987 he made the idea real—he hired a lawyer to draw up the papers, creating a public charity in Boston called Partners In Health and a corresponding “sister organization” in Haiti, Zanmi Lasante. Partners In Health would solicit and receive contributions, make them tax-free, and funnel the money, mostly Tom White’s, to Cange. White put up a million dollars as what he called “seed money.”
Farmer also turned to another well-heeled friend, his old classmate at Duke, Todd McCormack, who was now living in Boston. McCormack was amused at the notion that he, at twenty-eight and working in his father’s business, should be on the board of advisers of anything, but he knew Farmer was in earnest and he readily agreed. It seemed to McCormack that, for Paul, PIH wasn’t just a stratagem but also a way of trying to create a new communion. “It was a way he could institutionalize what he felt so passionately about, a vehicle through which his friends could participate,” McCormack would tell me. “Paul’s Catholic church.”
Some months after the official founding of PIH, Farmer expanded the group, adding a fellow Harvard anthropology and medical student, a Korean American named Jim Yong Kim. Jim joined PIH after a series of conversations with Paul in Boston, not unlike the long, windy chats Ophelia had with Paul in Port-au-Prince. Farmer offered what for Jim Kim was a convincing vision of the new organization. The reality was less impressive—a charity with a board of advisers and no hired staff except for a bibulous would-be poet, housed in a one-room office above a seafood restaurant in Cambridge. Paul, Ophelia, Jim, and Tom White were most of what there was to PIH, and they spent a great deal of time together. Sometimes the three young people would stay at one of Tom’s houses. Tom would go to bed long before they did and in the mornings growl at them, “I don’t know what you guys talk about all night long.”
They talked about issues such as political correctness, which Jim Kim defined as follows: “It’s a very well-crafted tool to distract us. A very self-centered activity. Clean up your own vocabulary so you can show everybody you have the social capital of having been in circles where these things are talked about on a regular basis.” (What was an example of political correctness? Some academic types would say to Jim and Paul, “Why do you call your patients poor people? They don’t call themselves poor people.” Jim would reply: “Okay, how about soon-dead people?”)
They talked about the insignificance of “cultural barriers” when it came to the Haitian peasant’s acceptance of modern Western medicine: “There’s nothing like a cure for a disease to change people’s cultural values.”
They talked about appearance: “The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don’t want you to look like them. They want you to dress in a suit and go get them food and water. Comma.”
Some people said that medicine addresses only the symptoms of poverty. This, they agreed, was true, and they’d make “common cause” with anyone sincerely trying to change the “political economies” of countries like Haiti. But it didn’t follow, as some self-styled radicals said, that good works without revolution only prolonged the status quo, that the only thing projects like Cange really accomplish is the creation of “dependency.” The poor were suffering. They were “dying like smelt.” Partners In Health believed in sending resources from the United States to Cange, down “the steep gradient of inequality,” so as to provide services to the desperately poor—directly, now. They called this “pragmatic solidarity,” a goofy term perhaps, but the great thing about it was that, if you really practiced it, you didn’t have to define it, you could simply point at what had been accomplished.
Paul and Jim and Ophelia would go out to dinner, and they’d still be talking about these matters when the restaurants shut down. Then they’d go to Jim’s apartment and talk some more. They spent a lot of time defining themselves, rather often by defining what they weren’t. WL’s were forever saying, “Things aren’t that black and white.” But some things were plenty black and white, they told each other—“areas of moral clarity,” which they called AMC’s. These were situations, rare in the world, where what ought to be done seemed perfectly clear. But the doing was always complicated, always difficult. They often talked about those difficulties. How Paul and Jim should balance work for PIH with going to school and getting their degrees. What PIH ought to do next in its adopted piece of Haiti, where AMC’s abounded.
Among many other things, they decided to build another school, in a desolate village near Cange—it was called Kay Epin, House of Pines, and it lacked almost everything, including much in the way of trees. Ophelia’s father put up the money, three thousand English pounds. On an evening in 1988 Farmer was hurrying around Cambridge, doing last-minute errands before flying to Haiti, where construction of the school was about to begin. He stepped off a curb and got hit by a car. It shattered his knee. So instead of going to Haiti, he went to the Massachusetts General Hospital. He languished there for weeks, then returned in a gigantic cast to the apartment he shared with Ophelia. She tried to nurse him.
Setting up routine housekeeping with Paul hadn’t led to a dwindling of affection. “I knew that he loved me. And I loved him,” she would say. But for her, relations were strained: “the strain of living with a fellow who was in love with something else, something that I could never compete with, even if I’d wanted to.” Often, if he could get away from medical school or his anthropology seminars early on Friday, he’d catch a flight to Haiti for a few days, sometimes just for the weekend. “Please don’t go,” she said to him on one of those occasions. “Stay with me.”
“Come with me,” he replied.
They argued. He told her, “I was clear about what I wanted to do with my life, and I thought you wanted to join me.”
Alone in the apartment afterward, she thought, “It’s true. He never said we’d go f
or walks in the woods, visit art museums, go to the opera.”
Everything got more difficult after the accident. Paul was restive in his clumsy cast, and angry because he yearned to get back to his clinic in Cange. She’d remind him he was supposed to keep weight off his broken leg, but he wouldn’t listen. She’d cook for him but he wouldn’t eat. She did her best, but she didn’t suffer silently. They had some rows. Finally, he said to her, “I’m going to Haiti. They don’t mind looking after me there.”
Years later, she’d still remember the date, December 10, 1988. They would patch up their quarrel, but inwardly she knew something had ended. When he proposed to her a couple of years later, she found it hard to say no but impossible to say yes. Hurt and angry, he told her, “If I can’t be your husband, I can’t be your friend. It would be too painful.”
For a time after that, she got her only news of him through Jim Kim. Away from Paul, her interest in becoming a doctor waned; she really didn’t like chemistry. But she hated the separation from Paul. More than ever he seemed to her like an important person to believe in. Not as a figure to watch from a distance, thinking, Oh, look, there is good in the world. Not as a comforting example, but the opposite. As proof that it was possible to put up a fight. As a goad to make others realize that if people could be kept from dying unnecessarily, then one had to act. She intended to remain part of PIH, and of Paul’s life. She knew he had a great weakness for forgiving people. It was, she thought, the most salient of his priestly qualities. “Gradually I filtered back,” she said.
Partners In Health was still being invented, the sort of organization where members could make up their own job descriptions. Once she had filtered back, Ophelia took on PIH’s finances and began scheming about creating an endowment. She insisted on being paid a salary, of about fifteen thousand dollars, and yearly contributed three times as much. As for relations with Paul, within a few years they seemed nearly perfect to her. Sometimes when he called her, fresh off the plane from Haiti, after a week or a month away, she’d picture herself his wife, uttering bitter recriminations. But there was none of that now. She simply felt happy at the prospect of seeing him again, and she could tell he felt the same when he appeared in the doorway. “Min!” he’d cry and reach out his arms to her, wearing a wild-looking grin, his face turning bright red. Only his sisters could make him laugh the way she did. It made her feel essential to him when she’d crack a bawdy joke about some mutual acquaintance and see him fall back onto a sofa, scissoring his feet in the air, laughing so hard that his asthma kicked up. He seemed to feel that he could tell her anything, now that he had no formal obligations to her. She’d say to herself sometimes, “Being his wife would have been no bargain. But to be his friend is simply wonderful.”
CHAPTER 11
In December 1988, Farmer returned to Cange in a wheelchair, and while his leg mended, he launched his study to improve TB treatment in the central plateau. Big events were happening in Cange, momentous events in Haiti. He witnessed some of those, once his leg had healed, on trips to Port-au-Prince. Several times he was in churches in the capital when shooting started, and he took refuge behind pillars.
Since the departure of Baby Doc Duvalier, various unelected governments had succeeded one another, but it was really the Haitian army that ruled the country from 1986 to 1990—with aid from the United States, as Farmer would discover, searching official, published documents. He was a student of Haitian history, and he knew that trading one corrupt, repressive, and unelected government for another was nothing new for the country or for American policy toward Haiti. Nor were uprisings among the impoverished majority. But it looked to him as though a great popular movement might really be in progress now.
With what seemed like unusual unanimity, the peasants and the people in the slums had embraced something called dechoukaj, the “uprooting” of every visible symbol of the Duvaliers, which included the public persecution and sometimes the killing of former tontons macoutes, mostly small fry, of course. The reaction of the Haitian army and its paramilitaries was extreme. There was violence on all sides, but as usual the side with guns and money was responsible for most of it. Farmer witnessed some of the incidents and heard about others; later he dug up verification: Haitian army soldiers shooting unarmed demonstrators, entering urban hospitals and threatening staff, sometimes executing patients, even stealing corpses now and then. In 1987 the army’s paramilitaries had massacred scores of voters at polling places, aborting what would have been the first democratic elections in Haiti’s history.
According to one old saying, perhaps less true by then than formerly, Haiti was 90 percent Catholic and 100 percent Voodoo. (Speaking of a devoutly Christian peasant, Farmer once said to me, “Of course he believes in Voodoo. He just believes it’s wrong.”) Catholic churches were at the center of the popular revolt—not the cathedrals where the Duvalierist hierarchy presided but what was called ti legliz, the small churches of the ruined countryside and of the cities’ slums. The most important of these was St. Jean Bosco in Port-au-Prince, where the priest Jean-Bertrand Aristide presided.
Farmer had first heard him speak in 1986, over the radio in Cange. He’d decided to go to Aristide’s church and hear him in person. The crowd was rapt, and so was Farmer. Aristide said, as Farmer remembered his words, “People read the Gospel as if it pertained to another place and time, but the struggles described there are in the here and now. The oppression of the poor, the abuse of the vulnerable, and the redemption that comes with fighting for what is right—what ideas could be more relevant in our dear Haiti?” Farmer remembered, “I’d been looking all over for the progressive, liberation theology church in Haiti, and here it was.” He joined the crowd that went up to meet Aristide after the Mass. Aristide could hardly have failed to notice him. (“Not many of his parishioners were white, tall, and Creolo-phone.”) They had become friends, but Farmer didn’t see much of Aristide in 1988. He was very busy himself in Cange, and Aristide was busy surviving a series of attempted assassinations, including the fire-bombing of his church, which the mayor of Port-au-Prince arranged.
Farmer was hoping for real change in Haiti, and meanwhile hating what he called “the tumble,” the turmoil and bloodshed and their inevitable by-product, the worsening of Haiti’s already wretched public health. On a day in 1989, he climbed alone to the top of a hill overlooking Cange. In Haiti, he didn’t usually write anything except official correspondence and thank-you notes. He didn’t usually have time, and besides, writing seemed much less important here than doctoring and building schools and water systems. But he was making an exception on this day, and he climbed the hill to do some work on his Ph.D. thesis in anthropology. “AIDS and Accusation,” he’d call it, the first of his alliterative titles.
AIDS had come to Cange about two years after he had, back in 1985. He was writing about its arrival in his thesis. He would catalog what he called “the geography of blame” and the scapegoat role assigned to Haiti. He’d tell the story of how, early in the AIDS epidemic in the United States, sociologists and even medical people had hypothesized that HIV had come from Africa to Haiti, then to the United States. Some experts even hypothesized that the disease had originated in Haiti, where, it was said by some, Voodoo houngans ripped the heads off chickens and guzzled their blood, then had sex with little boys. He’d write about how the Centers for Disease Control, a federal U.S. agency, had gone so far as to identify Haitians as a “risk group,” along with several other groups whose names began with h—homosexuals, hemophiliacs, and heroin users—and about the incalculable harm all this had done to Haiti’s fragile economy and to Haitians wherever they lived. In his thesis, he’d marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti, and might well have been carried there by American and Canadian and Haitian American sex tourists, who could buy assignations for pittances in a Port-au-Prince slum called Carrefour.
The thesis was to be an “interpretive anthropo
logy of affliction,” combining evidence from ethnography, history, epidemiology, and economics. It would begin, though, with the story of Cange. Following anthropological tradition, he’d give the village a pseudonym, Do Kay. Sitting on the hilltop, on a rocky outcropping, he wrote, “The best view of Do Kay is from atop one of the peculiarly steep and conical hills that nearly encircle the village.”
From where he sat, Cange looked like a collection of small dwellings scattered in no particular pattern on the side of an almost treeless mountain. There, near the top, was the house of Dieudonné, empty now because he’d died of AIDS last October. Over there near the road was the house where Anita Joseph had died of AIDS, slowly. A lot of painful memories were incorporated in the landscape. He remembered many other patients who had died, along with their lab data, and remembered vividly three young Haitians who had worked with him on the first health census of Cange: Acéphie, picked off by malaria, Michelet by typhoid, Ti-tap Joseph by puerperal sepsis. Good medicine could have prevented all those deaths. Each friend had died while in the care of doctors, in the typical, substandard Haitian medical facilities that Farmer had come to loathe.